Carbapenem is an organic heterobicyclic compound that consists of (5R)-1-azabicyclo[3.2.0]hept-2-ene bearing a 7-keto substituent. The parent of the class of carbapenems.
A group of beta-lactam antibiotics in which the sulfur atom in the thiazolidine ring of the penicillin molecule is replaced by a carbon atom. THIENAMYCINS are a subgroup of carbapenems that have a sulfur atom as the first constituent of the side chain. Carbapenem MM22383 is a carbapenemcarboxylic acid having a 2-(acetamidovinyl)sulfanyl group at the 2-position and an (S)-1-hydroxyethyl group at the 6-position. It has a role as an antibacterial drug and a drug allergen. It is a carbapenemcarboxylic acid and an alpha,beta-unsaturated monocarboxylic acid.
Mechanism Of Action
Information not available
Indications of Carbapenem
- Aspiration Pneumonia
- Bacteremia
- Bacterial Infection
- Bone infection
- Bronchitis
- Deep Neck Infection
- Endocarditis
- Endometritis
- Febrile Neutropenia
- Infection Prophylaxis
- Intraabdominal Infection
- Joint Infection
- Kidney Infections
- Lemierre’s Syndrome
- Meningitis
- Nosocomial Pneumonia
- Pelvic Infections
- Peritonitis
- Pneumonia
- Pneumonia with Cystic Fibrosis
- Septicemia
- Skin and Structure Infection
- Skin or Soft Tissue Infection
- Urinary Tract Infection
Intra-abdominal infections
The carbapenem ertapenem is one of several first-line agents recommended by the Infectious Disease Society of America for the empiric treatment of community-acquired intra-abdominal infections of mild-to-moderate severity. Agents with anti-pseudomonal activity, including doripenem, imipenem, and meropenem are not recommended in this population. Doripenem, imipenem, and meropenem are recommended for high-risk community-acquired abdominal infections and for abdominal infections that are hospital-acquired.[rx]
Complicated urinary tract infections
A 2015 systematic review found little evidence that would support the identification of the best antimicrobial regimen for complicated urinary tract infections but identified three high-quality trials supporting high cure rates with doripenem, including in patients with levofloxacin-resistant E. coli infections.[rx]
Pneumonia
The carbapenems imipenem and meropenem are recommended by the American Thoracic Society and the Infectious Disease Society of America as one of several first-line therapy options for people with late-onset hospital-acquired or ventilator-associated pneumonia, especially when Pseudomonas, Acinetobacter, or extended-spectrum beta-lactamase-producing Enterobacteriaceae are suspected pathogens. Combination therapy, typically with an aminoglycoside, is recommended for Pseudomonas infections to avoid resistance development during treatment.
Carbapenems are less commonly used in the treatment of community-acquired pneumonia, as community-acquired strains of the most common responsible pathogens (Streptococcus pneumoniae, Haemophilus influenza, atypical bacteria, and Enterobacteriaceae) are typically susceptible to narrower spectrum and/or orally administered agents such as fluoroquinolones, amoxicillin, or azithromycin. Imipenem and meropenem are useful in cases in which P. aeruginosa is a suspected pathogen.[rx]
Bloodstream Infections
A 2015 meta-analysis concluded that the anti-pseudomonal penicillin-beta lactamase inhibitor combination piperacillin-tazobactam gives results equivalent to treatment with a carbapenem in patients with sepsis.[rx] In 2015, the National Institute for Health and Care Excellence recommended piperacillin-tazobactam as first-line therapy for the treatment of bloodstream infections in neutropenic cancer patients.[rx]
For bloodstream infections known to be due to extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenems are superior to alternative treatments.[rx]
Spectrum of activity
Carbapenems exhibit broad-spectrum activity against gram-negative bacteria and somewhat narrower activity against gram-positive bacteria. For empiric therapy (treatment of infections prior to identification of the responsible pathogen) they are often combined with a second drug having broader spectrum gram-positive activity.
Contraindications of Carbapenem
Carbapenems are contraindicated in patients with prior allergic reactions to beta-lactam antibiotics. In addition, as the intramuscular formulations of ertapenem and imipenem are formulated with lidocaine, the intramuscular formulation of these two drugs are contraindicated in patients with prior adverse reactions to lidocaine.[rx][rx] Furthermore, carbapenems are also contraindicated in patients who are taking valproic acid for seizures, as it has been shown to decrease valproic acid concentrations by as much as 90%.[rx]
Dosage of Carbapenem
Due to their expanded spectra, the desire to avoid the generation of resistance, and the fact that, in general, they have poor oral bioavailability, they are administered intravenously in hospital settings for more serious infections. However, research is underway to develop an effective oral carbapenem.[rx]
Side Effects Of Carbapenem
The Most Common
- headache
- diarrhea
- constipation
- nausea
- vomiting
- pain
- redness, pain, or swelling at the injection site
- tingling or pricking sensation
- difficulty falling asleep or staying asleep
- sores in the mouth or throat
Common
- seizures
- severe diarrhea (watery or bloody stools) that may occur with or without fever and stomach cramps (may occur up to 2 months or more after your treatment)
- hives
- itching
- rash
- flushing
- swelling of the face, throat, tongue, lips, and eyes
- difficulty swallowing or breathing
- unusual tiredness or weakness
- pale skin
- fast or irregular heartbeat
- shortness of breath
- a return of fever or other signs of infection
Rare
- Agitation
- black, bloody, or tarry stools
- black, bloody vomit
- bloating or swelling of the face, arms, hands, lower legs, or feet
- blurred vision
- burning sensation while urinating
- burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
- cough
- dark urine
- decreased awareness or responsiveness
- decreased urine output
- depression
- diarrhea (watery and severe), which may also be bloody
- difficult or painful urination
- difficulty with breathing
- dilated neck veins
- extreme tiredness or weakness
- fever with or without chills
- headache
- hives or welts
- hostility
- irregular breathing
- irritability
- light-colored stools
- loss of consciousness
Drug Interactions of Carbapenem
- Information not available
References
